Usrn - Nclex, Clinical Review

1 week ago

Bengaluru, Karnataka, India Black & White Business Solutions Full time

Job Information:

Industry

Non-IT Lateral
***Province

Karnataka
***City

Bangalore North
***Postal Code

560001
***Country

India

Skill required:

***
Healthcare Management - Clinical Care Delivery Operations

Designation:

***
Senior Analyst

Job Location:

***
Bengaluru

Qualifications:

***
BSc. Nursing

Years of Experience:

***
5 to 8 years

What would you do?

  • Complete review of pended postservice claims for appropriateness of treatment setting,
- contractual reviews, or medical necessity.

  • Determine contract and benefit eligibility.
  • Follow and comply with all applicable regulatory and accreditation requirements.
  • Utilize applicable clientspecific medical policies, clinical guidelines, and/or client
- specific criteria
- sets (e.g., Milliman or InterQual) when performing clinical review.

  • Request additional clinical information as needed per client guidelines.
  • Route cases to the Client's physician reviewer for a determination when a service or admission
- does not meet medical necessity, place of service, or benefit criteria.

  • Maintain accurate and complete clinical and administrative case documentation using client
- approved templates.

  • Prepare detailed case summaries for physician review.
  • Consult with Radiant clinical leaders and/or U.S. licensed client physician reviewers as needed throughout the clinical claim review process.
  • Responsibilities exclude making adverse determinations or providing medical advice/opinion on
- treatment or services.

  • Support accreditation by knowing, understanding, correctly interpreting, and accurately applying
- accrediting and regulatory requirements and standards.

  • Data entry into client systems and route as appropriate.
  • Uses available resources to understand contractual and regulatory compliance requirements and
- reports suspected compliance issues on the day of discovery to a Team Lead, Manager, and/or the

  • Compliance Department.
  • Responsible for reporting known or suspected data disclosures on the day of discovery to a Team
  • Lead or Manager.

What are we looking for?

  • Holds current and unrestricted US Registered Nurse license.
  • Holds state specific RN licensure as required.
  • Excellent written and verbal communication skills in English.
  • Proficiency in basic computer knowledge with the ability to learn additional computer programs.
  • A minimum of three (3) months of prior working experience as a Registered Nurse in a clinical
- setting, preferred. o Three months is equivalent to 480 hours of working experience as an RN. o

  • Working experience as a Registered Nurse means holding an active RN license and providing direct
- patient care o Clinical setting includes inpatient hospital, outpatient hospital or clinic.
- and member benefits, preferred.

  • Strong analytical skills, preferred.
  • Strong customer service focus. o Ability to empathize, preferred. o Prioritizing customer needs,
- preferred. o Listening, patience & action oriented, preferred o Good understanding of phone
- etiquette, preferred.

  • Knowledge of ICD9 and ICD10 and CPT codes, preferred.
  • Experience in medical or insurance field, preferred.
  • Claim reviews/audit experience, preferred.
  • Experience in United States medical or insurance field, preferred.

Roles and Responsibilities

  • In this role you are required to do analysis and solving of increasingly complex problems
  • Your day to day interactions are with peers within company
  • You are likely to have some interaction with clients and/or management
  • You will be given mínimal instruction on daily work/tasks and a moderate level of instruction on new
- assignments

  • Decisions that are made by you impact your own work and may impact the work of others
  • In this role you would be an individual contributor and/or oversee a small work effort and/or team
  • Please note that this role may require you to work in rotational shifts

  • NCLEX Certified Nurse

    1 week ago

    Bengaluru, Karnataka, India 2coms Full time

    Job DescriptionOpportunity for Nclex certified Nurse with an MNC client, Bangalore.About the Client:Our client is a multinational professional services company that specializes in information technology (IT) services and consulting.Experience - 1+ yearsSkills - Specialized in Nursing.Must have Valid NCLEX certification.Location - BangaloreJOB REQUIREMENTS...

  • Clinical Data Specialist

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow. Who are we? A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence 20+ years of...

  • Clinical Data Specialist

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow.Who are we?A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence20+ years of...

  • Clinical Data Specialist

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow.Who are we? A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence 20+ years of...

  • Clinical Data Manager

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow.Who are we?A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence20+ years of...

  • Clinical Data Manager

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow. Who are we? A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence 20+ years of...

  • Clinical Data Manager

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow.Who are we?A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence20+ years of...

  • Senior Clinical Database Developer

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow.Who are we?A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence.20+ years of...

  • Senior Clinical Database Developer

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow. Who are we? A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence. 20+ years of...

  • 3 Days Left Clinical Data Manager

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow.Who are we? A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence 20+ years of...

  • Senior Clinical Database Developer Apply in 3 Minutes

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow.Who are we? A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence. 20+ years of...

  • Associate Clinical Data Reviewer

    1 week ago

    Bengaluru, Karnataka, India Clario Full time

    At Clario, we put people first, always. We are united and driven by patients, committed to making a difference, and we are always looking for the best talent to help us transform lives. We value the contribution each of our people brings. It's only through our people that we can continue to innovate technology that will shape the future of clinical trials.We...

  • Trainee - Clinical Research Coordinator

    1 week ago

    Bengaluru, Karnataka, India Clinical Research Institute Full time

    Job Description: Clinical Research TraineePosition Overview: A Clinical Research Trainee is an entry-level role within the field of clinical research, responsible for assisting in the planning, coordination, and execution of clinical trials and research studies aimed at evaluating the safety, efficacy, and effectiveness of new medical treatments, devices,...

  • Medical Reviewer

    1 week ago

    Bengaluru, Karnataka, India Novo Nordisk Full time

    Department - Centralised Monitoring Unit (CMU) Bangalore**About the departmentThe Centralised Monitoring Unit (CMU) Bangalore, is a department within the Clinical Drug Development area. It is a perfect blend of skilled medical professionals (Medical reviewers) and technical programmers (Functional programmers, statistical monitors). Medical reviewers...

  • Medical Reviewer

    1 week ago

    Bengaluru, Karnataka, India Novo Nordisk Full time

    Medical ReviewerCategory:Clinical DevelopmentLocation:Bangalore, Karnataka, IN**Department - Centralised Monitoring Unit (CMU) BangaloreAbout the department The Centralised Monitoring Unit (CMU) Bangalore, is a department within the Clinical Drug Development area. It is a perfect blend of skilled medical professionals (Medical reviewers) and technical...

  • Medical Data Reviewer

    1 week ago

    Bengaluru, Karnataka, India ICON Strategic Solutions Full time

    Serve as a Clinical Data reviewer and identify any errors in data by performing data review that require further clarification with the study site. Perform ongoing review of clinical/medical aspects of assigned patient data and documents (escalates to Client Clinical Scientist and/or medical monitor, as appropriate) Examples include but not limited to:...

  • Medical Data Reviewer

    1 week ago

    Bengaluru, Karnataka, India ICON Strategic Solutions Full time

    Serve as a Clinical Data reviewer and identify any errors in data by performing data review that require further clarification with the study site. Perform ongoing review of clinical/medical aspects of assigned patient data and documents (escalates to Client Clinical Scientist and/or medical monitor, as appropriate)Examples include but not limited to:...

  • Medical Data Reviewer

    1 week ago

    Bengaluru, Karnataka, India ICON Strategic Solutions Full time

    Serve as a Clinical Data reviewer and identify any errors in data by performing data review that require further clarification with the study site. Perform ongoing review of clinical/medical aspects of assigned patient data and documents (escalates to Client Clinical Scientist and/or medical monitor, as appropriate) Examples include but not limited to:...

  • Senior Medical Reviewer

    1 week ago

    Bengaluru, Karnataka, India Novo Nordisk AS Full time

    Department – Centralised Monitoring Unit (CMU) Does your motivation come from challenges and working in a dynamic environment? Do you thrive in a working environment where close collaboration with key stakeholders and strategic alignment is essential? Do you have a can-do attitude with continuous improvement as one of your career objectives? Then we...

  • Senior Project Finance Analyst/project Finance Analyst

    1 week ago

    Bengaluru, Karnataka, India George Clinical Full time

    We are expanding We have many new ground-breaking global clinical trial projects in various phases and therapeutic areas across the globe and want your ideas and expertise to help us build and grow.Who are we?A leading global clinical research organization founded in Asia-Pacific driven by scientific expertise and operational excellence20+ years of...